Complete excision of pelvic viscera for advanced carcinoma.A one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy

Brunschwig, Alexander

doi:10.1002/1097-0142(194807)1:2<177::aid-cncr2820010203>3.0.co;2-a

Cited by 600 publications

(190 citation statements)

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“…1 His surgical method comprises a one-staged abdominal-perineal operation with a total en masse resection of the pelvic organs, placement of an end-colostomy, and bilateral ureteral implantation above the colostomy. Brunschwig introduced the method as a way for symptomatic palliative care in subjects with advanced gynecological malignancies that do not respond to radiation therapy, who experience subsequent complications including fistula, infection, or pain.…”

Section: Introductionmentioning

confidence: 83%

“…He performed these operations with a high perioperative mortality rate of 23%. 1 Considerable progress has been made in the management of these patients as the method underwent substantial advances, and it was reported that the physical and psychological morbidity of exenterative surgery has decreased from 23% to 3-5%. 2 Heriot et al reported morbidity and mortality rates of 27% and 0.6% respectively.…”

Section: Introductionmentioning

confidence: 99%

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Supralevator Total Pelvic Exenteration Without Colostomy — Case Report

Botoncea¹,

Varlam

Chiujdea³

et al. 2017

Journal of Interdisciplinary Medicine

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Background: Pelvic exenteration is an ultra-radical surgical procedure described by Brunschwig in 1948, which attempts to surgically cure patients with recurrent pelvic cancer after radiotherapy. Several variants of pelvic exenteration are described that allow a more limited or extensive resection, depending on the stage of the disease. Case report: We report the case of a 54-year-old woman, who was diagnosed with a tumoral rectovaginal fistula after a recurrent cervical cancer that had been treated with a total hysterectomy with bilateral adnexectomy and a left percutaneous nephrostomy, as well as interaortocaval lymph node resection. The patient had undergone a supralevator total pelvic exenteration with pelvic and interaortocaval lymphadenectomy. The reconstruction process included right ureterostomy, left nephrostomy, and colocutaneous anal anastomosis (Parks procedure). Conclusions: Supralevator total pelvic exenteration provides hope for cure in patients with pelvic malignancies that reappear after radiotherapy. The restoration of the digestive tract and avoiding colostomy with a colocutaneous anastomosis increases the quality of life in these cases.

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Section: Introductionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Supralevator Total Pelvic Exenteration Without Colostomy — Case Report

Botoncea¹,

Varlam

Chiujdea³

et al. 2017

Journal of Interdisciplinary Medicine

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“…8 The exenteration was first defined by Brunschwig in 1948. 9 It can be classified into anterior, posterior or total exenteration, based on the involvement of the urinary bladder, the rectum or both in surgery. In relation to the levator ani muscle, it can be classified into supralevatorian, infralevatorian and infralevatorian with vulvectomy.…”

Section: Discussionmentioning

confidence: 99%

Total Infralevatorian Exenteration with Vulvectomy as Salvage Therapy in a Recurrent Irradiated Cervical Cancer with Pelvic Sidewall Involvement

Bécsi¹,

Szabó²,

Kiss³

et al. 2017

Journal of Interdisciplinary Medicine

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Despite the available effective screening techniques, cervical cancer is the most common genital malignancy in Romania. In patients with isolated pelvic recurrence after radiotherapy, exenteration represents the only chance for curative treatment. We present the case of a 45-year-old patient with a massive pelvic tumour causing intensive, poorly controlled vaginal bleeding, bilateral hydronephrosis and chronic renal failure. She underwent total infralevatorian exenteration with vulvectomy. Postoperative recovery was uneventful, and she presented a good evolution in the two months following surgery. We consider pelvic exenteration as the last treatment option to cure irradiated pelvic tumour recurrences. CASE REPORTWe present the case of a 45-year-old patient who was diagnosed with stage IIB squamous cervical carcinoma, complaining of atypical vaginal bleeding. She was referred to chemo-radiotherapy with curative intent. After five years she relapsed, complaining of lower abdominal pain and vaginal bleeding. Transrectal ultrasound (Figure 1) and magnetic resonance scan revealed a tumor of 8 × 4 cm, invading the parametrium bilaterally, the urinary bladder, the rectum, vagina, distal urethra, and the right internal iliac vessels. No distant metastases were described. The patient developed bilateral hydronephrosis with a nonfunctional right kidney. In September 2016, the patient had been admitted for intensive vaginal bleeding in order to attempt hemostasis and for blood transfusions.

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“…Brunschwig подробно описал технические аспекты выполнения тотальной инфралеваторной ЭМТ [9]. Эта техника без существенных изменений и сейчас использу-ется при операциях по поводу местно-распространенных опухолей малого таза.…”

Section: ключевые слова: рак прямой кишки эвисцерация малого таза мunclassified